Hurvitz E A, Conti G E, Flansburg E L, Brown S H
Department of Physical Medicine and Rehabilitation, Mott Children's Hospital, Ann Arbor, MI 48109-0230, USA.
Arch Phys Med Rehabil. 2000 Oct;81(10):1408-15. doi: 10.1053/apmr.2000.6293.
To evaluate changes in upper extremity function in a hemiparetic patient after treatment with botulinum toxin (BTX) using motor-control testing (MCT) techniques.
Interventional with longitudinal study, open label.
A children's hospital and a motor-control laboratory at a major academic center.
A 16-year-old male with right hemiparetic cerebral palsy and a healthy 12-year-old control subject.
BTX injections to the elbow and wrist flexors.
MCT was used to examine 4 upper extremity movements: forward reach, bilateral rhythmic movements (both muscle homologous and direction homologous), isometric pinch, and hand tapping. The patient was tested before treatment and at 2, 4, 6, 12, 18, and 24 weeks after treatment. In addition, range of motion (ROM), the Ashworth scale of spasticity, Functional Independence Measure, and the mobility and activities of daily living (ADL) sections of the Pediatric Evaluation of the Disability Inventory were performed.
Forward reach demonstrated little change initially despite patient reports of "feeling looser." Improvement was noted after 18 weeks, but returned to baseline level at 24 weeks. Bilateral rhythmic movements also showed slight improvement at 18 weeks. Pinch force increased significantly after 2 weeks, but declined again at 6 weeks. Improvements occurred in ROM and the Ashworth rating of spasticity, but were not temporally associated with each other or with MCT results. Functional assessment data did not change during the study period.
Improvements in more complex motor tasks were noted after significant delay from the time of treatment, while simpler tasks demonstrated a more rapid improvement, followed by a rapid return to baseline levels. This case suggests that MCT techniques can provide quantitative and qualitative data, which can add new information about upper extremity motor disability and the outcome of treatment.
采用运动控制测试（MCT）技术评估肉毒杆菌毒素（BTX）治疗后偏瘫患者上肢功能的变化。
纵向开放式干预研究。
一家儿童医院和一所主要学术中心的运动控制实验室。
一名16岁右偏瘫脑瘫男性患者和一名12岁健康对照受试者。
对肘部和腕部屈肌注射BTX。
MCT用于检查4种上肢运动：前伸、双侧节律性运动（肌肉同源和方向同源）、等长捏力和手部敲击。在治疗前以及治疗后2、4、6、12、18和24周对患者进行测试。此外，还进行了关节活动范围（ROM）、痉挛的Ashworth量表、功能独立性测量以及儿童残疾评定量表中的移动性和日常生活活动（ADL）部分的评估。
尽管患者报告“感觉更放松”，但最初前伸运动变化不大。18周后有改善，但在24周时恢复到基线水平。双侧节律性运动在18周时也有轻微改善。捏力在2周后显著增加，但在6周时再次下降。ROM和痉挛的Ashworth评分有所改善，但在时间上彼此之间或与MCT结果均无关联。功能评估数据在研究期间没有变化。
在治疗后显著延迟后，更复杂的运动任务有改善，而较简单的任务改善更快，随后迅速恢复到基线水平。该病例表明，MCT技术可以提供定量和定性数据，可为上肢运动残疾和治疗结果增添新信息。
